Dr. Caldwell Esselstyn Jr. has no qualms about stepping inside the nation's No. 1 heart hospital and dishing on angioplasty.

Invasive treatment is a mainstay of cardiac care, and it pays the bills. It's also what's wrong with medicine, says the retired Cleveland Clinic surgeon who has been affiliated with the hospital for 40 years.

Esselstyn has turned his life's work to demonstrating that heart disease doesn't need to exist in the first place. And if it does, it can be reversed. The remedy is a plant-based diet, he says.

Learn to live with no meat, no fish, no dairy or oils of any kind, and make yourself "heart-attack proof."

Most doctors would agree a strict vegetarian diet is good for the heart. But the idea that a diet free of animal products and fat can cure the No. 1 killer in America is a point of debate among doctors.

Drug companies are in fierce competition to find a cholesterol drug that does what Esselstyn argues can be done better through diet. The call to attack artery-clogging plaque naturally is a challenge to the medical profession and an unspoken threat to the bottom line of the medical industry.

But Esselstyn has the audacity to take his message to Cosgrove Country, where Clinic chief Toby Cosgrove is building a glassy new center for heart treatment while also trying to build a reputation for prevention and wellness programs.

One recent morning, Esselstyn slipped on a white lab coat and told a group assembled in a Clinic classroom that treating heart disease with stents and statins is not the answer. He implored them to accept that the body, given the right fuel, can restore coronary arteries damaged by the fatty Western diet.

Why a stent when the right diet will do?

Esselstyn, a stalky 6-foot-3 former Olympic gold medalist, pointed to white branches of the heart's plumbing system illuminated on an overhead screen. They were X-rays of arteries belonging to patients who took up his nutrition program. The X-rays showed vessels narrowed by disease that appeared to open after patients shunned burgers and fries for greens and grains.

"Why do you have to have an operation or stent?" Esselstyn asked rhetorically. "Your body can do this so simply."

Esselstyn and his wife, Ann, have followed a plant-based, oil-free diet for more than 20 years. He has studied a number of heart patients under his counsel during that time and reports their remarkable success in a recently published a book called "Prevent and Reverse Heart Disease."

He lives in Pepper Pike and is part of a small fraternity of prevention activists who say a vegetarian diet can protect the heart, the best known of whom is best-selling author Dr. Dean Ornish.

"What really keeps me on fire about this is we have an epidemic of disease in this country that doesn't need to exist," Esselstyn said in an interview. "It's so ridiculously simplistic to turn around this epidemic, it's scary."

A diet that callsfor extreme discipline

Simplistic perhaps, but demanding. The Esselstyn diet means never saying you ate "pretty good," or you only had a little ice cream.

• Quote: "I became disillusioned with a lot of what we were doing in medicine. No matter how many operations I did, I wasn't doing anything for the next victim."

Every forkful of fat, he says, causes an immediate biochemical assault on the endothelium, the lining of the arteries. White blood cells collect there, gobbling up bad cholesterol and creating fatty deposits over time.

For many people, especially those who smoke or have other risk factors, accumulation of plaque is a time bomb for a coronary event.

It might take something like that to convince an average meat-eater to adopt the Esselstyn diet. Even then, you wonder how many people at a heart attack survivors' convention would line up at his table.

Many doctors might agree with Esselsytn, but few are likely to push the no-mercy diet on patients, simply because it's thought to be unachievable.

"This diet is looked at as extreme as you can get, so many physicians instead of going to the extreme, go somewhere in the middle," said Dr. Joe Crowe, director of the breast center at the Clinic.

Crowe has followed Esselstyn's program since he suffered a heart attack at age 44 in 1996. He learned a new way of eating and said that once your taste buds adjust, you stop liking the taste of fat. You learn which restaurants to eat at and how to navigate social functions, which for Crowe involves moving stuff around the plate "so it looks like I've eaten something."

He was lean and healthy, with no sign of heart trouble when his heart attack struck. He learned that the lower third of a main artery leading to the front of his heart was significantly narrowed. They call this vessel the "widow maker." Crowe wasn't a candidate for surgical intervention, so he turned to Esselstyn. Two-and-a-half years later, an angiogram showed the diseased artery was normal.

A needfor large-scale trials?

Esselstyn has meticulously followed more than a dozen patients with advanced coronary disease who adopted his program. He writes in his book that patients saw cholesterol levels plummet and their angina disappear. After five years, 11 patients who underwent follow-up angiograms had stopped or reversed progression of the disease, he wrote.

"Patients with heart disease and their families, their greatest fear is when the next shoe is going to drop," Esselstyn said. "This is a very powerful gift they have given themselves and their families."

He counts cardiologists among those who have come knocking at his door for help. But he is first to admit he has not won a large number of believers at the Clinic. He tiptoes carefully on the subject of how his mantra plays there.

Dr. Steven Nissen, chairman of cardiovascular medicine at the Clinic, said Esselstyn's premise is unproven because nobody has conducted a rigorous study to show whether diet alone can reverse coronary disease.

"This is the reality," Nissen said. "We do the large-scale trials that somebody has to fund."

Nissen also cautioned that there is no "one-size-fits-all" answer for patients at risk for heart trouble. "I generally advise patients don't go out and buy a book and decide that's what you're going to do," he said.

But medicine should be a forum for different ideas, Nissen said.

On that count, the Clinic has made room for Essesltyn in his second career (he retired from surgery in 2000). He is part of the hospital's new Wellness Institute, headed by celebrity health guru Dr. Michael Roizen.

Esselstyn's wife, Ann, who is granddaughter of Clinic co-founder George Crile, is also a partner in his efforts. She authored a chapter in the book and contributed a volume of recipes, from banana french toast to veggie stuffed peppers.

Ann asks people she meets right off what they ate for lunch.

Together they counsel patients in their home, hosting four-hour sessions on how to shop, cook and eat in ways that most people never contemplated.

Ann accompanied her husband on his recent Clinic lecture, cradling a bundle of leafy greens to demonstrate the art of stripping leaf from stem.

Who knows? In an institution known for the best cardiac treatment in the world, kale and collard greens might be just what the doctor ordered.

So very happy to see this on the front page of the Plain Dealer. Dr. Esselstyn's recommendations make so much sense. I adopted a vegan diet about 3 years ago. Although I don't adhere to the strict no-fat diet for heart patients, I do try to eat whole plant-based foods and I feel so much better. Most physicians don't even mention diet, unless you are overweight. But as Dr. Crowe can attest to, you don't need to be overweight to be at risk. American's need to rethink what they are putting in their mouths.

I saw John Belluardo speak. He had had several coronary bipass operations before trying Esselstyn's diet. Once on the diet, his heart actually grew new vasculature, his body repaired itself, and he is now running half-marathons again. He swears by Dr. Esselstyn's diet.

I am vegan already -- which I think has made a huge difference in helping me to stay young looking, fit and healthy -- but since hearing that talk, and reading Esselstyn's book, I've been reducing my oil consumption with the goal of eliminating it from my diet.

One resource that I have found helpful for making the switch to a vegan diet is www.ChooseVeg.com.

In the article, some of the doctors considered the diet to be extreme, but I think paying tens of thousands of dollars, going under the knife, having your chest cut open, and risking the brain damage that can occur during these operations is extreme -- especially when you consider that they are only temporary fixes!

Doctors need to give their patients this information so they can make informed decisions. To withhold it from them is akin to malpractice. Weather they do it or not, is up to them. But when you are facing an immanent death, you would be surprised at how motivated a person can get.

Anyone having health concerns involving heart disease should get Dr. Esselstyn's book, and attend one of his lectures...very interesting and engaging.
Anyone considering surgery should research this option. We are fortunate to have him in our own town.
A plant based diet is the basis of his work...for those interested in finding out more about the benefits of a plant based diet,please attend a delicious free vegan dinner and lecture at:
Cleveland Heights Library, 2345 Lee Rd., Cleveland Heights, OH
Thursday June 26th, 6:30 p.m. - 8:30 p.m
Visit www.mercyforanimals.org for more info listed under Events, Ohio.

As a senior in my 60's I have some arthritis. Four years ago I envisioned myself being handicapped by the arthritis. Today, I still have the arthritis, but the progression has been halted. Four years ago I became vegetarian for moral and ethical reasons. Today, I'm vegan.

It's nice to see such positive comments! After begin vegan for less than a year, my cholesterol level decreased by 38 points. I'm trying to get my mom to adopt a vegan diet so she can stop taking her liver-damaging cholesterol medication.

This is what the focus of medicine should be. Not surgery, NOT drugs, but diet and herbs. It's such a sin that this information is not being given out by hospitals and government. You know why? Because too many industries stand to lose with you not developing all the killer diseases of this country. There is so much money involved, they don't want you to take the natural, less expensive way out. Also, the meat and dairy will not allow government to tell the truth about diet...that plant based is the way.

As I now have 7 stents after a double bi-pass 1997 and the Doctors @ Lenox Hill Hospital told me not to buy long term(0ne year out) securities, would the diet help a person like myself.
The fact is plague keeps forming and I feel tired too much, I sleep about 10 hours a day.
As I wrote until about 6 months ago I ran 4 miles a day & worked out at the gym.
My last stent was 7/29/08, bi-pass early 97, non invasive, minimal chest opening.The MD at St. Francis Hosp. in NY wanted to do three however he was unable too.

Some might find Jerry Brunetti's video lecture, "Food as Medicine", interesting. Brunetti claims cardiovascular illnesses are driven by sugar not fats. He praises certain fats, and is critical of carbs and refined sugars. He claims that native cultures within the Arctic Circle have the healthiest cardiovascular systems on Earth, yet subsist entirely on high animal fat diets.

Here's a retired surgeon, probably with more money than he knows what to do with, yet he won't share his supposedly life-saving information free of charge on the Internet. We have to buy his book! I'm all for free enterprise, but when you're already set financially and you've taken the Hippocratic oath, what's wrong with just helping people free of charge? Has his Hippocratic Oath become a hypocritic one?